Contract Details
Facility name
Forest City Diagnostic Imaging Center
Provider ID
P000004405
NPI
1386755700
Tax ID
364227239
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
735 North Perryville Rd Lower Level 3
Rockford, IL 61107
United States
County
Winnebago
Phone
8153981300 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address